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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: This SPA adds conforming updates in state law, including commissioner authority to grant variance of behavioral health home service provider requirements; clarification of provider requirements and expectations; corrects the list of qualified positions for a Qualified Health Home Specialist, and adds requirement for Behavioral Health Home (BHH) providers to notify the contact designated by an enrollee’s managed care plan within 30 days of the start of BHH services.
Summary: The purpose of this SPA is to assume the responsibility of enrolling practices, other than Federally Qualified Health Centers or Rural Health Clinics, into the Comprehensive Primary Care Plus (CPC+) program; establish enrollment qualifications for Tracks 1 and 2; and describe a methodology under State Plan Section 4.19-B to pay performance-based incentives to CPC+ providers based on utilization measures and quality measure
Summary: This SPA is to update Attachment 3.1-F to align with the new Managed Care Contracts effective January 1, 2022 and to add new services delivered by the MCO.
Summary: Approved the State’s request to amend its State Plan to add a new 1915 Home and Community Based Services (HCBS) benefit. As part of the SPA, Illinois revised its 3.1-F pages, which authorizes Managed Care under 1932(a) to include the new 1915 program.
Summary: The purpose of this SPA is to allow for passive enrollment of BadgerCare Plus and SSI-Related Medicaid beneficiaries, who are required to join a Health Maintenance Organization, effective December 11, 2021.
Summary: This SPA is to include language in the South Carolina State Plan to allow managed care coverage for treatment of beneficiaries in Opioid Treatment Programs and inpatient freestanding psychiatric treatment facilities.
Summary: Effective July 1, 2021, this amendment redefines the payment limit to eligible medical professionals of UNC Health Care and ECU Physicians from a unique count of eligible medical professional providers to an aggregate dollar cap in preparation for the North Carolina Medicaid Transformation to Managed Care.
Summary: Effective July 1, 2021, this amendment revises the methodology for calculating hospital specific Medicaid ratio of costs to charges (RCCs) in preparation for the North Carolina Medicaid Transformation to Managed Care. The amendment will also discontinue hospital outpatient supplemental payments, increase hospital RCCs, and define how to establish hospital RCC’s for new hospitals and changes of ownership.
